Abstract
Introduction: Prolonged prone positioning, exceeding 16 h, has been associated with reduced mortality among patients with moderate to severe acute respiratory distress syndrome (ARDS). Extending the duration of prone positioning may provide greater therapeutic benefits. This study aims to assess the clinical outcomes between 16 h and 24 h prone positioning therapy in patients with moderate to severe ARDS. Methods: This prospective randomized clinical trial was conducted in the intensive care unit of a university-affiliated tertiary medical center. Patients were randomly assigned to receive either 16 h or 24 h prone positioning therapy. All participants were managed according to a standardized protocol incorporating low tidal volume and protective lung strategies. Results: Out of 45 patients diagnosed with moderate to severe ARDS requiring mechanical ventilation, 21 were allocated to the 16 h prone positioning group and 24 were assigned to the 24 h group. There were no significant differences in PaO(2)/FiO(2) ratios, driving pressure, or serum lactate levels between the two groups. The first session of prone positioning resulted in significantly greater PaO(2)/FiO(2) improvement compared to the second session. The 24 h group showed a trend toward requiring fewer prone positioning sessions than the 16 h group. Secondary outcomes did not differ significantly between groups. Conclusions: Both 16 h and 24 h prone positioning therapies improved oxygenation in patients with moderate to severe ARDS. The 24 h prone group showed a trend toward fewer sessions, potentially reducing clinical workload. The first prone session provided greater oxygenation improvement compared to the second session.